Responding to the Need for Innovation in GME

One of the most exciting developments in medical education happened last summer when the Institute of Medicine (IOM) released a new report, “Graduate Medical Education That Meets the Nation’s Health Needs.” The report was requested in 2012 by the Josiah Macy Jr. Foundation and supported by 11 other private foundations as well as 11 United States Senators. The Report Brief outlines the IOM’s intriguing conclusions about the governance and financing of Graduate Medical Education (GME). The recommendations highlight the immense need for innovation in the way Graduate Medical Education is structured, distributed, designed, and implemented. The report suggests that a portion of the Medicare GME fund be designated as a “Transformation Fund,” intended to finance innovation and experimentation in GME.

Physicians and medical educators have published responses to the IOM report, most notably in the New England Journal of Medicine. In a Perspective piece, “Innovation in Medical Education,” David Asch and Debra Weinstein contend that the evidence base that informs our practice in medical education is disproportionately underdeveloped as compared to the clinical realm, where “no one questions the need for sustained support for research in cancer, heart disease, or dementia.” Why fund research on these conditions without funding similar research on the training of the physicians tasked with their treatment? The authors write, “Despite medical education’s central role in creating a workforce capable of delivering the resulting biomedical advances…funding for medical education research is conspicuously absent.”

At Harvard Medical School, we have designed and implemented an innovative new program to train talented medical educators to be skilled investigators. The Master of Sciences (MMSc) in Medical Education is a two-year degree open to physicians, medical students, and others with a doctoral degree relevant to the health professions. Our program blends formal coursework with the opportunity to conduct high-quality mentored research culminating in a Master’s thesis that is amenable to peer review and publication in the medical literature.

Much of the formal coursework in the program fosters the development of research skills relevant to medical education research. For example, our students take courses in qualitative methods as well as quantitative methods. In addition, they receive training in cognitive science, curriculum development, principles of assessment, adult learning, and other content essential for medical educators and master teachers. Our program is proud to have a close collaboration with the Harvard Macy Institute (HMI), allowing students to receive course credit for two courses offered by the HMI, including the Program for Educators in Health Professions and the Leading Innovations in Healthcare and Education program.

The field of medical education will not make meaningful forward progress without high-quality data to guide our practice. The Transformation Fund is the IOM’s suggested remedy, intended to support methodologically-rigorous studies and innovative approaches to challenges, and measure outcomes, in GME. Asch and Weinstein note that GME is facing crucial questions, each amenable to systematic investigation, such as:

How do we develop competent physicians whose competence will be sustained throughout their careers?

How should the funds which support the GME enterprise be allocated?

What are the most meaningful, patient-centered outcomes of GME and how can we measure those with validity and feasibility?

Should graduation from a particular phase of training be based on duration of training of competence achieved?

How do we ensure a physician workforce that aligns optimally with the health needs of our nation?

These are questions of pivotal importance which can only be answered with the dedication of time, financial resources, and research expertise. If you are an educator who has been inspired by the essential dialogue sparked by the IOM report, please consider applying for our degree program. The admissions season for students entering in September 2015 is now open. We look forward to training the medical education researchers of the future because it is only with guidance from rigorous research that will we have data with which to make informed choices about how to train tomorrow’s health care providers.

Jennifer Kesselheim, MD (pictured), is founding director of Harvard Medical School’s new master of Medical Sciences in Medical Education program. She is a member of The Academy at Harvard Medical School and serves as the associate fellowship program director for Education in the Division of Pediatric Hematology–Oncology at Boston Children’s Hospital and Dana-Farber Cancer Institute. She can be reached at Jennifer_Kesselheim@dfci.harvard.edu. Ayres Heller, MEd, is Program Manager of the Masters in Medical Sciences (MMSc) in Medical Education degree at Harvard Medical School. She manages all operations of the new degree program, which welcomed its first cohort of students in September 2014. She can be reached at Ayres_Heller@hms.harvard.edu.